Hyperaldosteronism is treated either with surgery to remove the affected adrenal gland or with medications that block the hormone aldosterone from damaging your body. The right approach depends on whether one or both adrenal glands are overproducing aldosterone, and whether the problem originates in the adrenal glands themselves (primary) or is driven by another condition like kidney disease (secondary).
Primary vs. Secondary: Why the Cause Matters
In primary hyperaldosteronism, one or both adrenal glands produce too much aldosterone on their own, usually because of a benign tumor on one gland or overgrowth of both glands. Treatment targets the adrenal glands directly. In secondary hyperaldosteronism, something outside the adrenal glands, most commonly reduced blood flow to the kidneys, triggers the overproduction. Treatment focuses on correcting that underlying cause rather than the adrenal glands themselves.
Most people searching for treatment information have primary hyperaldosteronism, which is far more commonly diagnosed. The rest of this article focuses primarily on that condition.
Surgery for One-Sided Disease
When excess aldosterone comes from a single adrenal gland, surgical removal of that gland offers the best chance of a lasting fix. The procedure is almost always done laparoscopically, meaning small incisions and a relatively quick recovery. Before surgery is recommended, imaging and a specialized test called adrenal venous sampling confirm which gland is the source.
The results are strong. In one long-term study from a UK center, 88% of patients experienced meaningful clinical improvement after surgery, and nearly 96% achieved complete biochemical cure, meaning their aldosterone levels returned to normal. “Complete clinical success,” defined as normalized blood pressure without medication, was achieved in about 29% of patients in the short term and rose to roughly 42% over the long term. Most of the remaining patients still needed some blood pressure medication but at lower doses and with better control than before surgery.
After the operation, blood pressure and aldosterone levels are typically monitored within the first one to three months, with a final assessment between six and twelve months. Your doctor will check your aldosterone-to-renin ratio and potassium levels to confirm the cure took hold.
Medication When Surgery Isn’t an Option
If both adrenal glands are overproducing aldosterone, or if you’re not a candidate for surgery, medications become the long-term treatment. The Endocrine Society recommends a class of drugs called mineralocorticoid receptor antagonists (MRAs) as first-line therapy. These medications block aldosterone from binding to receptors in your kidneys and blood vessels, preventing it from raising your blood pressure and depleting your potassium.
Spironolactone is the preferred MRA due to its lower cost and wide availability. The typical starting dose ranges from 12.5 to 50 mg per day, though people with primary hyperaldosteronism often need higher doses than those taking it for ordinary high blood pressure. Doses above 100 mg daily generally add little extra blood pressure benefit. For people with an adrenal tumor who choose medical management over surgery, doses of 100 to 200 mg are sometimes used.
Spironolactone vs. Eplerenone
Spironolactone is clearly the more powerful option. In a head-to-head trial, spironolactone lowered systolic blood pressure by an average of 27 mmHg compared to just 10 mmHg with eplerenone. Diastolic blood pressure dropped 12.5 mmHg with spironolactone versus 5.6 mmHg with eplerenone. Response rates favored spironolactone at every check-in over 16 weeks.
The tradeoff is side effects. Spironolactone interacts with hormone receptors beyond aldosterone, which leads to breast tissue enlargement (gynecomastia) in about 21% of men, breast pain in a similar percentage, and sexual side effects in roughly 6%. These problems are dose-dependent: they occur in about 7% of men taking less than 50 mg per day but climb to 50% at doses above 150 mg. Eplerenone is far more selective, so gynecomastia drops to around 4.5% and breast pain essentially disappears. Women taking spironolactone may experience menstrual irregularities.
If spironolactone side effects become intolerable, switching to eplerenone is the standard next step. You’ll likely need a higher dose of eplerenone to get comparable blood pressure control, and your doctor will adjust upward based on your response.
Alternatives Beyond MRAs
For people who can’t tolerate either MRA, potassium-sparing diuretics like amiloride offer a backup option. Amiloride works differently: instead of blocking the aldosterone receptor, it blocks sodium channels in the kidney, which helps retain potassium. Doses of 10 to 40 mg per day have been shown to raise potassium levels in primary hyperaldosteronism patients. However, amiloride can trigger a compensatory rise in aldosterone levels, which may partly undermine its own effect over time. It’s considered a reasonable alternative, not a first choice.
Reducing Salt Makes a Real Difference
Aldosterone causes your body to retain sodium, so limiting salt intake works with your medication rather than against it. A clinical trial called salt CONNtrol found that patients with primary hyperaldosteronism who reduced their daily salt intake from about 9 grams to 5 grams experienced meaningful drops in blood pressure and, notably, improvements in depressive symptoms. The effect was even stronger when patients were already on MRA therapy, suggesting the two approaches amplify each other.
Five grams of salt per day is roughly one teaspoon. Most of the sodium in a typical diet comes from processed and restaurant foods rather than the salt shaker, so reading labels and cooking more meals at home are the most practical steps.
Treating Secondary Hyperaldosteronism
When aldosterone overproduction is driven by another condition, treatment means fixing that root cause. The most common culprit is narrowing of the arteries that supply the kidneys (renal artery stenosis), which tricks the body into producing excess aldosterone to raise blood pressure and retain fluid. Restoring blood flow to the kidneys, sometimes through a stenting procedure, can resolve the aldosterone excess. Heart failure and liver cirrhosis can also cause secondary hyperaldosteronism, and managing those conditions typically brings aldosterone levels down. ACE inhibitors, which interrupt the hormonal chain that stimulates aldosterone release, are often effective in these situations because they address the signaling problem rather than just blocking aldosterone at the receptor.
What to Expect Long Term
If you have surgery, the potassium problem almost always resolves completely. Blood pressure improves in the vast majority of patients, though many still need at least one blood pressure medication afterward, especially if they had high blood pressure for years before diagnosis. The longer hypertension has been present, the less likely surgery is to eliminate the need for medication entirely.
If you’re on long-term MRA therapy, regular blood work is important. Both spironolactone and eplerenone can raise potassium levels too high, particularly in people with reduced kidney function. Small decreases in sodium levels are also common. Your doctor will check these values periodically and adjust your dose. Most people on medical therapy achieve good blood pressure and potassium control, though it may take several dose adjustments over the first few months to find the right balance between effectiveness and side effects.